As a reminder, BCBSRI in-network and out-of-network behavioral health services only require a notification of admission.
Per this process, admitting facilities must notify BCBSRI behavioral health within 48 hours of a member’s admission to/discharge from any one of the following levels of care, to ensure correct claims processing:
- Inpatient mental health
- Inpatient withdrawal management (detoxification)/rehab
- Crisis stabilization
- Residential treatment center (mental health and/or substance use disorder)
- Partial hospitalization (mental health and/or substance use disorder)
- Intensive outpatient (mental health and/or substance use disorder)
- Child and family intensive treatment (CFIT)
- Applied behavior analysis (ABA)
- Transcranial magnetic stimulation (TMS)
Of note, the Federal Employee Program (FEP) is exempt from the notification of admission process. A medical necessity review is still required for the following in-network behavioral health services:
- Inpatient mental health
- Inpatient withdrawal management
- Residential treatment center (mental health and/or substance use disorder)
- Applied behavior analysis (ABA)
- Transcranial magnetic stimulation (TMS)